Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness

National guidance and clinical guidelines recommended multidisciplinary teams (MDTs) for cancer services in order to bring specialists in relevant disciplines together, ensure clinical decisions are fully informed, and to coordinate care effectively. However, the effectiveness of cancer teams was not previously evaluated systematically. A random sample of 72 breast cancer teams in England was studied (548 members in six core disciplines), stratified by region and caseload. Information about team constitution, processes, effectiveness, clinical performance, and members' mental well-being was gathered using appropriate instruments. Two input variables, team workload (P=0.009) and the proportion of breast care nurses (P=0.003), positively predicted overall clinical performance in multivariate analysis using a two-stage regression model. There were significant correlations between individual team inputs, team composition variables, and clinical performance. Some disciplines consistently perceived their team's effectiveness differently from the mean. Teams with shared leadership of their clinical decision-making were most effective. The mental well-being of team members appeared significantly better than in previous studies of cancer clinicians, the NHS, and the general population. This study established that team composition, working methods, and workloads are related to measures of effectiveness, including the quality of clinical care

Challenges and proposed framework for formative research to inform systematic intervention development in rare and unstudied conditions: The case example of Xeroderma Pigmentosum

Purpose: To outline the challenges of applying existing systematic intervention development approaches in rare diseases, and to propose a novel framework within which these challenges can be met. Background: A gap in the provision of self-management and psychosocial interventions to change behaviour and improve health in rare diseases exists, partly due to the difficulty of conducting formative research in such conditions. Challenges include heterogeneity within already small sample sizes, patient burden, and the absence of prior research to guide decision-making. XP is a very rare inherited disease (~100 UK patients), involving an inability to repair ultraviolet radiation (UVR)-induced damage and increased melanoma risk; the only treatment is complete photoprotection. No research in XP has been conducted outside of the genetic literature. Methods: Using XP and improved photoprotection as a case example, we highlight the necessity of departing from the steps outlined by three intervention development approaches (intervention mapping, UK MRC guidelines for complex interventions, behaviour change wheel), and outline a framework that can be applied to the conduct of formative research in rare diseases. The framework focuses on the sequential or parallel use of mixed-methods (e.g., n-of-1, interviews, reviews of comparable conditions) and the triangulation of gathered data, and provides solutions to challenges including patient burden and the inability to pre-test study materials or intervention content in members of the target population. Conclusions: The proposed framework offers an alternative that may overcome the limitations associated with intervention development in rare diseases, which will hopefully encourage much-needed work in this field

The response of neuregulin 1 mutant mice to acute restraint stress

Stress plays a role in the development and severity of psychotic symptoms and there may be a genetic component to stress vulnerability in schizophrenia. Using an established mouse model for schizophrenia, we investigated the behavioural and endocrine response of Nrg1 transmembrane domain mutant mice (Nrg1 HET) and wild type-like (WT) littermates to acute restraint stress. Animals were screened at 3-4 months and 6-7 months of age (before and after onset of hyperlocomotion) for open field behaviour and serum corticosterone levels. In younger mice, stress reduced locomotive and explorative measures and increased anxiety-like behaviour regardless of genotype. Older Nrg1 mutants were less susceptible to the effects of stress on anxiety-related behaviours. All mice responded to restraint stress with robust increases in serum corticosterone. Importantly, the stress-induced increase in corticosterone was more pronounced in Nrg1 mutant than WT mice at the younger but not the older age. Our results suggest that transmembrane domain Nrg1 has only a moderate effect on the acute stress response of mice. The behavioural differences detected between WT and Nrg1 HET mice at the older age were evident without parallel modifications to the glucocorticoid system

Rapid response to abalone virus depletion in western Victoria: information acquisition and reef code assessment

Future management of disease-affected abalone must adapt to the changing circumstances, and adopting a precautionary approach will allow maximum potential for stock recovery. This approach is mandated by the observation that no documented examples are known of abalone populations recovering from catastrophic impacts such as have occurred in the abalone fisheries of Victoria's Western and Central zones. Indeed the balance of international evidence points towards the contrary, so these fisheries are in dangerous territory. This need not mean that recovery cannot occur. However, the modelling results from this project confirm the above precautionary view and suggest that unless it is known with certainty that disease-induced mortalities have been moderate (less than 40%), then any resumption of fishing in the near term risks the future of the fishery. Acquisition of accurate mortality data is the only basis upon which fishing can recommence in the short term (within 5 years) and in many instances, such as for some among those reefs considered in our study, the opportunity has passed. The simulation results provide guidance, but their validity is conditional on myriad assumptions as well as on the accuracy of data employed. We already know that catches early in the fishery’s history were higher than reported officially, but how much higher is conjecture. Growth is highly variable over small spatial scales and feedback effects from reduced abundance together with changed size structure and persistence of habitat will play roles in determining the rate, if any, of recovery. The extent of the contemporary illegal catch is uncertain, particularly given the unprecedented closure of the fisheries. The results show that even small illegal catches can significantly degrade recovery where the viral impact is high, with clear implications for the enforcement aspects of managing these fisheries